|
PR RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 25260
|
| Min. Negotiated Rate |
$382.12 |
| Max. Negotiated Rate |
$1,314.00 |
| Rate for Payer: Aetna Commercial |
$778.22
|
| Rate for Payer: Aetna Medicare |
$580.76
|
| Rate for Payer: BCBS Complete |
$401.23
|
| Rate for Payer: BCBS MAPPO |
$580.76
|
| Rate for Payer: BCN Commercial |
$977.53
|
| Rate for Payer: BCN Medicare Advantage |
$580.76
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Commercial |
$836.29
|
| Rate for Payer: Cofinity Commercial |
$778.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.76
|
| Rate for Payer: Healthscope Commercial |
$696.91
|
| Rate for Payer: Healthscope Whirlpool |
$696.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$609.80
|
| Rate for Payer: Meridian Medicaid |
$401.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$638.84
|
| Rate for Payer: Nomi Health Commercial |
$696.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: PACE SWMI |
$580.76
|
| Rate for Payer: PHP Medicare Advantage |
$580.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$382.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,044.96
|
| Rate for Payer: Priority Health Medicare |
$580.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,044.96
|
| Rate for Payer: Railroad Medicare Medicare |
$580.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,095.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$580.76
|
| Rate for Payer: UHC Exchange |
$1,095.10
|
| Rate for Payer: UHC Medicaid |
$382.12
|
| Rate for Payer: UHCCP DNSP |
$580.76
|
| Rate for Payer: UHCCP Medicaid |
$382.12
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
HCPCS 25270
|
| Min. Negotiated Rate |
$300.33 |
| Max. Negotiated Rate |
$1,095.75 |
| Rate for Payer: Aetna Commercial |
$611.12
|
| Rate for Payer: Aetna Medicare |
$456.06
|
| Rate for Payer: BCBS Complete |
$315.35
|
| Rate for Payer: BCBS MAPPO |
$456.06
|
| Rate for Payer: BCN Commercial |
$762.90
|
| Rate for Payer: BCN Medicare Advantage |
$456.06
|
| Rate for Payer: Cash Price |
$1,168.80
|
| Rate for Payer: Cash Price |
$1,168.80
|
| Rate for Payer: Cofinity Commercial |
$656.73
|
| Rate for Payer: Cofinity Commercial |
$611.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$456.06
|
| Rate for Payer: Healthscope Commercial |
$547.27
|
| Rate for Payer: Healthscope Whirlpool |
$547.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$478.86
|
| Rate for Payer: Meridian Medicaid |
$315.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$501.67
|
| Rate for Payer: Nomi Health Commercial |
$547.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,095.75
|
| Rate for Payer: PACE SWMI |
$456.06
|
| Rate for Payer: PHP Medicare Advantage |
$456.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$815.53
|
| Rate for Payer: Priority Health Medicare |
$456.06
|
| Rate for Payer: Priority Health Narrow Network |
$815.53
|
| Rate for Payer: Railroad Medicare Medicare |
$456.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$854.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$456.06
|
| Rate for Payer: UHC Exchange |
$854.22
|
| Rate for Payer: UHC Medicaid |
$300.33
|
| Rate for Payer: UHCCP DNSP |
$456.06
|
| Rate for Payer: UHCCP Medicaid |
$300.33
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
HCPCS 25272
|
| Min. Negotiated Rate |
$341.65 |
| Max. Negotiated Rate |
$1,252.50 |
| Rate for Payer: Aetna Commercial |
$697.13
|
| Rate for Payer: Aetna Medicare |
$520.25
|
| Rate for Payer: BCBS Complete |
$358.73
|
| Rate for Payer: BCBS MAPPO |
$520.25
|
| Rate for Payer: BCN Commercial |
$861.01
|
| Rate for Payer: BCN Medicare Advantage |
$520.25
|
| Rate for Payer: Cash Price |
$1,336.00
|
| Rate for Payer: Cash Price |
$1,336.00
|
| Rate for Payer: Cofinity Commercial |
$749.16
|
| Rate for Payer: Cofinity Commercial |
$697.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$520.25
|
| Rate for Payer: Healthscope Commercial |
$624.30
|
| Rate for Payer: Healthscope Whirlpool |
$624.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$546.26
|
| Rate for Payer: Meridian Medicaid |
$358.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$572.27
|
| Rate for Payer: Nomi Health Commercial |
$624.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,252.50
|
| Rate for Payer: PACE SWMI |
$520.25
|
| Rate for Payer: PHP Medicare Advantage |
$520.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$920.39
|
| Rate for Payer: Priority Health Medicare |
$520.25
|
| Rate for Payer: Priority Health Narrow Network |
$920.39
|
| Rate for Payer: Railroad Medicare Medicare |
$520.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$970.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$520.25
|
| Rate for Payer: UHC Exchange |
$970.49
|
| Rate for Payer: UHC Medicaid |
$341.65
|
| Rate for Payer: UHCCP DNSP |
$520.25
|
| Rate for Payer: UHCCP Medicaid |
$341.65
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN
|
Professional
|
Both
|
$2,371.00
|
|
|
Service Code
|
HCPCS 25274
|
| Min. Negotiated Rate |
$392.77 |
| Max. Negotiated Rate |
$1,778.25 |
| Rate for Payer: Aetna Commercial |
$803.33
|
| Rate for Payer: Aetna Medicare |
$599.50
|
| Rate for Payer: BCBS Complete |
$412.41
|
| Rate for Payer: BCBS MAPPO |
$599.50
|
| Rate for Payer: BCN Commercial |
$1,021.86
|
| Rate for Payer: BCN Medicare Advantage |
$599.50
|
| Rate for Payer: Cash Price |
$1,896.80
|
| Rate for Payer: Cash Price |
$1,896.80
|
| Rate for Payer: Cofinity Commercial |
$863.28
|
| Rate for Payer: Cofinity Commercial |
$803.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.50
|
| Rate for Payer: Healthscope Commercial |
$719.40
|
| Rate for Payer: Healthscope Whirlpool |
$719.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.48
|
| Rate for Payer: Meridian Medicaid |
$412.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$659.45
|
| Rate for Payer: Nomi Health Commercial |
$719.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,778.25
|
| Rate for Payer: PACE SWMI |
$599.50
|
| Rate for Payer: PHP Medicare Advantage |
$599.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$392.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,092.34
|
| Rate for Payer: Priority Health Medicare |
$599.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,092.34
|
| Rate for Payer: Railroad Medicare Medicare |
$599.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,158.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$599.50
|
| Rate for Payer: UHC Exchange |
$1,158.84
|
| Rate for Payer: UHC Medicaid |
$392.77
|
| Rate for Payer: UHCCP DNSP |
$599.50
|
| Rate for Payer: UHCCP Medicaid |
$392.77
|
|
|
PR RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT
|
Professional
|
Both
|
$2,086.00
|
|
|
Service Code
|
HCPCS 25275
|
| Min. Negotiated Rate |
$397.88 |
| Max. Negotiated Rate |
$1,564.50 |
| Rate for Payer: Aetna Commercial |
$813.41
|
| Rate for Payer: Aetna Medicare |
$607.02
|
| Rate for Payer: BCBS Complete |
$417.77
|
| Rate for Payer: BCBS MAPPO |
$607.02
|
| Rate for Payer: BCN Commercial |
$1,032.31
|
| Rate for Payer: BCN Medicare Advantage |
$607.02
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: Cofinity Commercial |
$874.11
|
| Rate for Payer: Cofinity Commercial |
$813.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.02
|
| Rate for Payer: Healthscope Commercial |
$728.42
|
| Rate for Payer: Healthscope Whirlpool |
$728.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$637.37
|
| Rate for Payer: Meridian Medicaid |
$417.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$667.72
|
| Rate for Payer: Nomi Health Commercial |
$728.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,564.50
|
| Rate for Payer: PACE SWMI |
$607.02
|
| Rate for Payer: PHP Medicare Advantage |
$607.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,103.51
|
| Rate for Payer: Priority Health Medicare |
$607.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,103.51
|
| Rate for Payer: Railroad Medicare Medicare |
$607.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,169.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$607.02
|
| Rate for Payer: UHC Exchange |
$1,169.28
|
| Rate for Payer: UHC Medicaid |
$397.88
|
| Rate for Payer: UHCCP DNSP |
$607.02
|
| Rate for Payer: UHCCP Medicaid |
$397.88
|
|
|
PR RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 28210
|
| Min. Negotiated Rate |
$253.47 |
| Max. Negotiated Rate |
$732.02 |
| Rate for Payer: Aetna Commercial |
$518.58
|
| Rate for Payer: Aetna Medicare |
$387.00
|
| Rate for Payer: BCBS Complete |
$266.14
|
| Rate for Payer: BCBS MAPPO |
$387.00
|
| Rate for Payer: BCN Commercial |
$638.41
|
| Rate for Payer: BCN Medicare Advantage |
$387.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$557.28
|
| Rate for Payer: Cofinity Commercial |
$518.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.00
|
| Rate for Payer: Healthscope Commercial |
$464.40
|
| Rate for Payer: Healthscope Whirlpool |
$464.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.35
|
| Rate for Payer: Meridian Medicaid |
$266.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$425.70
|
| Rate for Payer: Nomi Health Commercial |
$464.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.25
|
| Rate for Payer: PACE SWMI |
$387.00
|
| Rate for Payer: PHP Medicare Advantage |
$387.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$682.44
|
| Rate for Payer: Priority Health Medicare |
$387.00
|
| Rate for Payer: Priority Health Narrow Network |
$682.44
|
| Rate for Payer: Railroad Medicare Medicare |
$387.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$732.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$387.00
|
| Rate for Payer: UHC Exchange |
$732.02
|
| Rate for Payer: UHC Medicaid |
$253.47
|
| Rate for Payer: UHCCP DNSP |
$387.00
|
| Rate for Payer: UHCCP Medicaid |
$253.47
|
|
|
PR RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS
|
Professional
|
Both
|
$8,951.00
|
|
|
Service Code
|
HCPCS 33877
|
| Min. Negotiated Rate |
$2,099.54 |
| Max. Negotiated Rate |
$6,713.25 |
| Rate for Payer: Aetna Commercial |
$4,454.88
|
| Rate for Payer: Aetna Medicare |
$3,324.54
|
| Rate for Payer: BCBS Complete |
$2,204.52
|
| Rate for Payer: BCBS MAPPO |
$3,324.54
|
| Rate for Payer: BCN Commercial |
$5,272.13
|
| Rate for Payer: BCN Medicare Advantage |
$3,324.54
|
| Rate for Payer: Cash Price |
$7,160.80
|
| Rate for Payer: Cash Price |
$7,160.80
|
| Rate for Payer: Cofinity Commercial |
$4,787.34
|
| Rate for Payer: Cofinity Commercial |
$4,454.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,324.54
|
| Rate for Payer: Healthscope Commercial |
$3,989.45
|
| Rate for Payer: Healthscope Whirlpool |
$3,989.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,490.77
|
| Rate for Payer: Meridian Medicaid |
$2,204.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,656.99
|
| Rate for Payer: Nomi Health Commercial |
$3,989.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,713.25
|
| Rate for Payer: PACE SWMI |
$3,324.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,324.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,099.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,669.50
|
| Rate for Payer: Priority Health Medicare |
$3,324.54
|
| Rate for Payer: Priority Health Narrow Network |
$5,669.50
|
| Rate for Payer: Railroad Medicare Medicare |
$3,324.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,496.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,324.54
|
| Rate for Payer: UHC Exchange |
$6,496.60
|
| Rate for Payer: UHC Medicaid |
$2,099.54
|
| Rate for Payer: UHCCP DNSP |
$3,324.54
|
| Rate for Payer: UHCCP Medicaid |
$2,099.54
|
|
|
PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 55060
|
| Min. Negotiated Rate |
$225.78 |
| Max. Negotiated Rate |
$667.05 |
| Rate for Payer: Aetna Commercial |
$464.15
|
| Rate for Payer: Aetna Medicare |
$346.38
|
| Rate for Payer: BCBS Complete |
$237.07
|
| Rate for Payer: BCBS MAPPO |
$346.38
|
| Rate for Payer: BCN Commercial |
$573.68
|
| Rate for Payer: BCN Medicare Advantage |
$346.38
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cofinity Commercial |
$498.79
|
| Rate for Payer: Cofinity Commercial |
$464.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.38
|
| Rate for Payer: Healthscope Commercial |
$415.66
|
| Rate for Payer: Healthscope Whirlpool |
$415.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.70
|
| Rate for Payer: Meridian Medicaid |
$237.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$381.02
|
| Rate for Payer: Nomi Health Commercial |
$415.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$486.75
|
| Rate for Payer: PACE SWMI |
$346.38
|
| Rate for Payer: PHP Medicare Advantage |
$346.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$624.91
|
| Rate for Payer: Priority Health Medicare |
$346.38
|
| Rate for Payer: Priority Health Narrow Network |
$624.91
|
| Rate for Payer: Railroad Medicare Medicare |
$346.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$667.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$346.38
|
| Rate for Payer: UHC Exchange |
$667.05
|
| Rate for Payer: UHC Medicaid |
$225.78
|
| Rate for Payer: UHCCP DNSP |
$346.38
|
| Rate for Payer: UHCCP Medicaid |
$225.78
|
|
|
PR RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 36575
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$345.75 |
| Rate for Payer: Aetna Commercial |
$39.57
|
| Rate for Payer: Aetna Medicare |
$29.53
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS MAPPO |
$29.53
|
| Rate for Payer: BCN Commercial |
$49.30
|
| Rate for Payer: BCN Medicare Advantage |
$29.53
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$39.57
|
| Rate for Payer: Cofinity Commercial |
$42.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.53
|
| Rate for Payer: Healthscope Commercial |
$35.44
|
| Rate for Payer: Healthscope Whirlpool |
$35.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.01
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.48
|
| Rate for Payer: Nomi Health Commercial |
$35.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.75
|
| Rate for Payer: PACE SWMI |
$29.53
|
| Rate for Payer: PHP Medicare Advantage |
$29.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$53.01
|
| Rate for Payer: Priority Health Medicare |
$29.53
|
| Rate for Payer: Priority Health Narrow Network |
$53.01
|
| Rate for Payer: Railroad Medicare Medicare |
$29.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.53
|
| Rate for Payer: UHC Exchange |
$62.08
|
| Rate for Payer: UHC Medicaid |
$18.96
|
| Rate for Payer: UHCCP DNSP |
$29.53
|
| Rate for Payer: UHCCP Medicaid |
$18.96
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS INCARCERATED
|
Professional
|
Both
|
$1,507.00
|
|
|
Service Code
|
HCPCS 49582
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$1,130.25 |
| Rate for Payer: BCBS Complete |
$602.80
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.25
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 49580
|
| Min. Negotiated Rate |
$522.40 |
| Max. Negotiated Rate |
$979.50 |
| Rate for Payer: BCBS Complete |
$522.40
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$979.50
|
|
|
PR RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,736.00
|
|
|
Service Code
|
HCPCS 49587
|
| Min. Negotiated Rate |
$694.40 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: BCBS Complete |
$694.40
|
| Rate for Payer: Cash Price |
$1,388.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,302.00
|
|
|
PR RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,507.00
|
|
|
Service Code
|
HCPCS 49585
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$1,130.25 |
| Rate for Payer: BCBS Complete |
$602.80
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.25
|
|
|
PR RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC
|
Professional
|
Both
|
$8,282.00
|
|
|
Service Code
|
HCPCS 33414
|
| Min. Negotiated Rate |
$1,273.31 |
| Max. Negotiated Rate |
$6,211.50 |
| Rate for Payer: Aetna Commercial |
$2,686.07
|
| Rate for Payer: Aetna Medicare |
$2,004.53
|
| Rate for Payer: BCBS Complete |
$1,336.98
|
| Rate for Payer: BCBS MAPPO |
$2,004.53
|
| Rate for Payer: BCN Commercial |
$3,154.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,004.53
|
| Rate for Payer: Cash Price |
$6,625.60
|
| Rate for Payer: Cash Price |
$6,625.60
|
| Rate for Payer: Cofinity Commercial |
$2,886.52
|
| Rate for Payer: Cofinity Commercial |
$2,686.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,004.53
|
| Rate for Payer: Healthscope Commercial |
$2,405.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,405.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,104.76
|
| Rate for Payer: Meridian Medicaid |
$1,336.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,204.98
|
| Rate for Payer: Nomi Health Commercial |
$2,405.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,211.50
|
| Rate for Payer: PACE SWMI |
$2,004.53
|
| Rate for Payer: PHP Medicare Advantage |
$2,004.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,273.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,392.49
|
| Rate for Payer: Priority Health Medicare |
$2,004.53
|
| Rate for Payer: Priority Health Narrow Network |
$3,392.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2,004.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,833.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,004.53
|
| Rate for Payer: UHC Exchange |
$3,833.71
|
| Rate for Payer: UHC Medicaid |
$1,273.31
|
| Rate for Payer: UHCCP DNSP |
$2,004.53
|
| Rate for Payer: UHCCP Medicaid |
$1,273.31
|
|
|
PR RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER
|
Professional
|
Both
|
$2,908.00
|
|
|
Service Code
|
HCPCS 26428
|
| Min. Negotiated Rate |
$503.32 |
| Max. Negotiated Rate |
$2,181.00 |
| Rate for Payer: Aetna Commercial |
$1,008.40
|
| Rate for Payer: Aetna Medicare |
$752.54
|
| Rate for Payer: BCBS Complete |
$528.49
|
| Rate for Payer: BCBS MAPPO |
$752.54
|
| Rate for Payer: BCN Commercial |
$1,200.63
|
| Rate for Payer: BCN Medicare Advantage |
$752.54
|
| Rate for Payer: Cash Price |
$2,326.40
|
| Rate for Payer: Cash Price |
$2,326.40
|
| Rate for Payer: Cofinity Commercial |
$1,083.66
|
| Rate for Payer: Cofinity Commercial |
$1,008.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$752.54
|
| Rate for Payer: Healthscope Commercial |
$903.05
|
| Rate for Payer: Healthscope Whirlpool |
$903.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$790.17
|
| Rate for Payer: Meridian Medicaid |
$528.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$827.79
|
| Rate for Payer: Nomi Health Commercial |
$903.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,181.00
|
| Rate for Payer: PACE SWMI |
$752.54
|
| Rate for Payer: PHP Medicare Advantage |
$752.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$503.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,283.44
|
| Rate for Payer: Priority Health Medicare |
$752.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,283.44
|
| Rate for Payer: Railroad Medicare Medicare |
$752.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,318.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$752.54
|
| Rate for Payer: UHC Exchange |
$1,318.75
|
| Rate for Payer: UHC Medicaid |
$503.32
|
| Rate for Payer: UHCCP DNSP |
$752.54
|
| Rate for Payer: UHCCP Medicaid |
$503.32
|
|
|
PR RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR
|
Professional
|
Both
|
$2,042.00
|
|
|
Service Code
|
HCPCS 26426
|
| Min. Negotiated Rate |
$303.53 |
| Max. Negotiated Rate |
$1,531.50 |
| Rate for Payer: Aetna Commercial |
$617.61
|
| Rate for Payer: Aetna Medicare |
$460.90
|
| Rate for Payer: BCBS Complete |
$318.71
|
| Rate for Payer: BCBS MAPPO |
$460.90
|
| Rate for Payer: BCN Commercial |
$777.35
|
| Rate for Payer: BCN Medicare Advantage |
$460.90
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cofinity Commercial |
$663.70
|
| Rate for Payer: Cofinity Commercial |
$617.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.90
|
| Rate for Payer: Healthscope Commercial |
$553.08
|
| Rate for Payer: Healthscope Whirlpool |
$553.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.94
|
| Rate for Payer: Meridian Medicaid |
$318.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$506.99
|
| Rate for Payer: Nomi Health Commercial |
$553.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,531.50
|
| Rate for Payer: PACE SWMI |
$460.90
|
| Rate for Payer: PHP Medicare Advantage |
$460.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$303.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$830.97
|
| Rate for Payer: Priority Health Medicare |
$460.90
|
| Rate for Payer: Priority Health Narrow Network |
$830.97
|
| Rate for Payer: Railroad Medicare Medicare |
$460.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$870.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$460.90
|
| Rate for Payer: UHC Exchange |
$870.64
|
| Rate for Payer: UHC Medicaid |
$303.53
|
| Rate for Payer: UHCCP DNSP |
$460.90
|
| Rate for Payer: UHCCP Medicaid |
$303.53
|
|
|
PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
HCPCS 33226
|
| Min. Negotiated Rate |
$269.87 |
| Max. Negotiated Rate |
$1,002.00 |
| Rate for Payer: Aetna Commercial |
$570.12
|
| Rate for Payer: Aetna Medicare |
$425.46
|
| Rate for Payer: BCBS Complete |
$283.36
|
| Rate for Payer: BCBS MAPPO |
$425.46
|
| Rate for Payer: BCN Commercial |
$717.09
|
| Rate for Payer: BCN Medicare Advantage |
$425.46
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cofinity Commercial |
$612.66
|
| Rate for Payer: Cofinity Commercial |
$570.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.46
|
| Rate for Payer: Healthscope Commercial |
$510.55
|
| Rate for Payer: Healthscope Whirlpool |
$510.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$446.73
|
| Rate for Payer: Meridian Medicaid |
$283.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$468.01
|
| Rate for Payer: Nomi Health Commercial |
$510.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,002.00
|
| Rate for Payer: PACE SWMI |
$425.46
|
| Rate for Payer: PHP Medicare Advantage |
$425.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$771.14
|
| Rate for Payer: Priority Health Medicare |
$425.46
|
| Rate for Payer: Priority Health Narrow Network |
$771.14
|
| Rate for Payer: Railroad Medicare Medicare |
$425.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$883.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$425.46
|
| Rate for Payer: UHC Exchange |
$883.90
|
| Rate for Payer: UHC Medicaid |
$269.87
|
| Rate for Payer: UHCCP DNSP |
$425.46
|
| Rate for Payer: UHCCP Medicaid |
$269.87
|
|
|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 33215
|
| Min. Negotiated Rate |
$175.51 |
| Max. Negotiated Rate |
$795.00 |
| Rate for Payer: Aetna Commercial |
$366.42
|
| Rate for Payer: Aetna Medicare |
$273.45
|
| Rate for Payer: BCBS Complete |
$184.29
|
| Rate for Payer: BCBS MAPPO |
$273.45
|
| Rate for Payer: BCN Commercial |
$458.64
|
| Rate for Payer: BCN Medicare Advantage |
$273.45
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Cofinity Commercial |
$393.77
|
| Rate for Payer: Cofinity Commercial |
$366.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.45
|
| Rate for Payer: Healthscope Commercial |
$328.14
|
| Rate for Payer: Healthscope Whirlpool |
$328.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.12
|
| Rate for Payer: Meridian Medicaid |
$184.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$300.80
|
| Rate for Payer: Nomi Health Commercial |
$328.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$795.00
|
| Rate for Payer: PACE SWMI |
$273.45
|
| Rate for Payer: PHP Medicare Advantage |
$273.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$493.21
|
| Rate for Payer: Priority Health Medicare |
$273.45
|
| Rate for Payer: Priority Health Narrow Network |
$493.21
|
| Rate for Payer: Railroad Medicare Medicare |
$273.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$549.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$273.45
|
| Rate for Payer: UHC Exchange |
$549.72
|
| Rate for Payer: UHC Medicaid |
$175.51
|
| Rate for Payer: UHCCP DNSP |
$273.45
|
| Rate for Payer: UHCCP Medicaid |
$175.51
|
|
|
PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 36597
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Aetna Commercial |
$69.79
|
| Rate for Payer: Aetna Medicare |
$52.08
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$52.08
|
| Rate for Payer: BCN Commercial |
$88.64
|
| Rate for Payer: BCN Medicare Advantage |
$52.08
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Cofinity Commercial |
$75.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.08
|
| Rate for Payer: Healthscope Commercial |
$62.50
|
| Rate for Payer: Healthscope Whirlpool |
$62.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.68
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.29
|
| Rate for Payer: Nomi Health Commercial |
$62.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
| Rate for Payer: PACE SWMI |
$52.08
|
| Rate for Payer: PHP Medicare Advantage |
$52.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.33
|
| Rate for Payer: Priority Health Medicare |
$52.08
|
| Rate for Payer: Priority Health Narrow Network |
$95.33
|
| Rate for Payer: Railroad Medicare Medicare |
$52.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$52.08
|
| Rate for Payer: UHC Exchange |
$107.64
|
| Rate for Payer: UHC Medicaid |
$33.23
|
| Rate for Payer: UHCCP DNSP |
$52.08
|
| Rate for Payer: UHCCP Medicaid |
$33.23
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE
|
Professional
|
Both
|
$1,342.00
|
|
|
Service Code
|
HCPCS 90380
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$1,006.50 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: BCBS Trust/PPO |
$595.06
|
| Rate for Payer: BCN Commercial |
$547.23
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,006.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$595.06
|
| Rate for Payer: UHC Exchange |
$595.06
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE
|
Professional
|
Both
|
$1,342.00
|
|
|
Service Code
|
HCPCS 90381
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$1,006.50 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: BCBS Trust/PPO |
$595.06
|
| Rate for Payer: BCN Commercial |
$547.23
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,006.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$595.06
|
| Rate for Payer: UHC Exchange |
$595.06
|
|
|
PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 90678
|
| Min. Negotiated Rate |
$300.90 |
| Max. Negotiated Rate |
$648.75 |
| Rate for Payer: Aetna Commercial |
$300.90
|
| Rate for Payer: BCBS Trust/PPO |
$319.07
|
| Rate for Payer: BCN Commercial |
$325.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.07
|
| Rate for Payer: UHC Exchange |
$319.07
|
|
|
PR RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE
|
Professional
|
Both
|
$821.00
|
|
|
Service Code
|
HCPCS 90679
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$615.75 |
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: BCBS Trust/PPO |
$306.35
|
| Rate for Payer: BCN Commercial |
$289.29
|
| Rate for Payer: Cash Price |
$656.80
|
| Rate for Payer: Cash Price |
$656.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.35
|
| Rate for Payer: UHC Exchange |
$306.35
|
|
|
PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
|
Professional
|
Both
|
$3,034.00
|
|
|
Service Code
|
HCPCS 37193
|
| Min. Negotiated Rate |
$192.55 |
| Max. Negotiated Rate |
$2,275.50 |
| Rate for Payer: Aetna Commercial |
$406.69
|
| Rate for Payer: Aetna Medicare |
$303.50
|
| Rate for Payer: BCBS Complete |
$202.18
|
| Rate for Payer: BCBS MAPPO |
$303.50
|
| Rate for Payer: BCN Commercial |
$504.96
|
| Rate for Payer: BCN Medicare Advantage |
$303.50
|
| Rate for Payer: Cash Price |
$2,427.20
|
| Rate for Payer: Cash Price |
$2,427.20
|
| Rate for Payer: Cofinity Commercial |
$437.04
|
| Rate for Payer: Cofinity Commercial |
$406.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.50
|
| Rate for Payer: Healthscope Commercial |
$364.20
|
| Rate for Payer: Healthscope Whirlpool |
$364.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.68
|
| Rate for Payer: Meridian Medicaid |
$202.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.85
|
| Rate for Payer: Nomi Health Commercial |
$364.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,275.50
|
| Rate for Payer: PACE SWMI |
$303.50
|
| Rate for Payer: PHP Medicare Advantage |
$303.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$543.01
|
| Rate for Payer: Priority Health Medicare |
$303.50
|
| Rate for Payer: Priority Health Narrow Network |
$543.01
|
| Rate for Payer: Railroad Medicare Medicare |
$303.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$624.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.50
|
| Rate for Payer: UHC Exchange |
$624.96
|
| Rate for Payer: UHC Medicaid |
$192.55
|
| Rate for Payer: UHCCP DNSP |
$303.50
|
| Rate for Payer: UHCCP Medicaid |
$192.55
|
|
|
PR RUBELLA IMMUNIZATION, SUBCUT
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90706
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
|
